I think it depends on what the setting is. If it's through office visits, then I believe that initially diagnostic tests will attempt to rule out any acute process. If P.T., tens or any other regimen doesn't work, the MD starts becoming skeptical and starts downplaying your symptoms. In the ltc facility where I work, I find chronic pain to be almost totally ignored which tees me off. The elderly, frail/debilitated should be vindicated in their woes of aches and pains. And that's just it. Just because they're elderly and arthritic, this pain is to be expected but is seldom addressed. I find the issue of pain control, or the lack of it, to be a big sore spot with me. It has been proven that children, ca pts. and all others are (too) many times unacknowledged and therefore, undermedicated.

Aug 17, '00

Hi Earle! I agree with what you are saying, but in the hospital setting I am seeing something quite different and upsetting. One doctor we have who specializes in pain control, admits his patients on my unit and we always dread their arrival. These patients tend to have a common bond, aside from complaints of back pain. Once they are hooked up to their PCA's and taking 300mg of Demerol Q4H, as well as 10mg Valium IV Q6, they begin to talk about life's hurts, and theirs are ones that would break your heart. I can't help but feel sorry for them, yet it does seem like thier pain is more psychosomatic, and that by giving them enough drugs to knock out a horse, we are creating a new problem for them. I am not talking about terminal patients, I am speaking of 30'ish women who can walk, and have families, etc...Really, I have seen these people barely able to talk, falling asleep in mid sentence with their hands clutching that PCA button, ringing the call bell to request one of their PRN's which by this time you are almost afraid to give them for fear of killing them. Inevitably a psych consult is brought in and they are transferred to a psych facility!

And on the other end of the spectrim, when I did work in LTC, I had an elderly woman dying of ca of the pancreas who would SCREAM in pain. All that the MD gave her is Darvocet, Talwin, and a duragesic patch! I fought with my DON one weekend who ordered me not to call the doctor for anything more for her as she said he wouldn't give her anymore pain meds. She told me I'd be fired if I called him. It damned near killed ME to listen to her screams. I made sure that she got all of her meds though, spacing the PRN's so that she was getting one of them every two hours, but it seemed criminal.

So to answer the question of effective pain control? No! I don't see chronic pain being treated effectively or even differentiated appropriately.

Aug 18, '00

I had my first experience of how some doctors ignore chronic pain while I was still a student. I still regret not having the guts to do a better job of advocating for the patient, but I was still young and innocent, and expected the MD to do something. The patient had an extremely painful condition: TB of the spine. She was on a morphine drip, which was not controlling the pain properly. After upping the rate of the drip a couple of times, they switched to a Duragesic patch, which was no better. She told me one day as I was doing her bed bath, that "I prayed last night to God to let me die." You could hear her constant moans for some distance down the hall.

I reported the above conversation in the MD's communication book. He came on the ward later in the morning, glanced at the book, then WALKED AWAY, RIGHT PAST THE PT'S ROOM, WITHOUT DOING *@&%* ALL!!!

Eventually, they took her away to surgery to do some sort of a spinal block on her. I don't know how successful it was, as she did not return to the ward after.

In my current job, so far I've seen most MD's willing to deal with pain in terminally ill cancer patients in an appropriate, humane fashion, BUT I still keep hearing horror stories about MD's who are afraid to medicate pt's enough for fear of killing them. This is despite abundant research which shows narcotics do not appreciably shorten the lifespan of someone who's terminally ill. I really think all the doctors out there should be forced to take courses in palliation which cover appropriate pain management. I highly recommend a little book called "The Pain Manual: Principles and Issues in Cancer Pain Managment" by Dr. S. Lawrence Librach and Dr. Bruce P. Squires. It's published by Pegasus Healthcare International (Montreal, Toronto) and I think copies are available through the Canadian Cancer Society.

Aug 18, '00

Hey Bunk,

I see what you mean, in the hospital setting. What were the dx's that got them Demerol & Valium in those dosages? Would they get it if they weren't in the acute setting and suffered these everyday pains? I've been on my knees, crippled with back pain from injuries on the job(can anyone relate?) with visible muscle spasms and elevated vitals and was prescribed ibuprofen 800 mg. q6h....I've gone to my doctor 2x in 4 years r/t these injuries so she couldn't call me a med-seeking lunatic. The second time, my husband was with me because I couldn't drive and when she wrote a script for Motrin, I almost choked her. My husband went to the medical director, made a scene and was then given a script for Vicodin & Valium. I can't even imagine feeling intense pain qd and being ignored. I would literally go insane. But then again, I am quite the wimp sometimes. Anyway, please address my new topic under general nsg. discussion because I (WE!) need help on this one.

Aug 18, '00

The dx's that got that kind of one two whammy combo was "S/P Lumbar Laminectomy Syndrome". I'd have been on the floor with less than a 1/4 of either of those drugs, yet incredibly these people withstood it and still asked for more, more, more!

Aug 18, '00

I think that it all depends on the doctor. I have fibromyalgia and migraines. The doctor that I see now, and have for the past two years is absolutely wonderful. He knows that I prefer not to take medications if I can at all avoid it. He has been very helpful as far as making sure that I get the proper treatment for my pain, whether it is through PT or chiropractic or, yes, even meds. If I have a flare-up, he does everything in his power to help me get through it, even if it means using Darvocet or Percocet for a while.
However, the doctors that I saw previously were nothing like that at all. In fact, most of them dismissed my pain and told me to go see a psychiatrist. For a while a few years back, I was in so much pain that I was actually passing out about every 5 minutes. I was treated in the ER at the Mayo Clinic, where I was told that passing out was my body's way of getting a break from the pain. Still, my doctor decided that I was making everything up.

So, I guess that I would say that for the most part, I do not think that doctors are not treating chronic pain appropriately. Whether it is that they are afraid of their patients becoming addicted to pain meds or whatever else the case is, I would say that most chronic pain patients are being undertreated. I just got to be one of the lucky ones who, at the present time, does not fall into that category.

Aug 19, '00

As a general rule, I don't believe patient's are getting proper pain relief. As an LPN turned Nursing Student, and most importantly a chronic pain patient, I see people struggle on a daily basis, trying to find a doctor who will treat their chronic pain, allowing them to get on with living life. I suffered many years with inadequate pain relief. Not only was the pain intolerable, but the repeated "turning of the back" by the medical establishment took it's toll on my psyche. I dealt with comments like, "It's all in your head," or "Go home and learn how to live with it." Of course I was put through the many grueling diagnostic and injection/cautarizing type treatment. I lost count years ago, as to how many procedures I have had to undergo, almost as a way of proving how much pain I was in. Pain is an individual tolerance type thing. Medication has proven to be the most suitable way of treating the chronic pain patient, without causing the un-necessary trauma and costly procedures of the 21st century. Give the patients the relief they need. Let them back to the land of the productive, and thriving member of society they so desparately wish to be a part of. The doctors should not have to fear loss of their license in doing so either. I am sure they would use more aggressive treatment, if their wasn't such a fear.
Sincerely, Debbie Rich
LPN/Nursing Student/chronic pain patient/
State Pain Representative for ActiononPain.com

Aug 19, '00

Hi,
I do not feel that in most cases, our chronic pain customers are having their pain managed appropriately . I feel that the management of chronic pain is something that many physicians and nurses, I've got to include myself, are not properly trained to handle. For instance, there is an article under news in this website that talks about nurse telephone access for people suffering from depression. Now I would not suggest that depression necessarily proceeded chronic pain for many suffers, I'm just suggesting that the medical model of pain management is not complete. There needs to be more focus on holistic modalities of managing pain which includes the medical model. The management of pain is more subjective then objective. Some chronic pain suffers respond optimally to alternative health and medicine after failing with the scientific way of managing pain.

Aug 19, '00

Hi. My mother suffered for years and years with chronic back pain, becoming more and more dibilitated, and never really being diagnosed accurately; partly her fault, partly the docs. Finally, after an unrelated hospital stay, I insisted she be placed in a LTC facility, close to my home, for rehabilitation and strengthening. The care she received, included pain control for her chronic condition. She began to get stronger with each passing week, and for the first time in so many years, her back pain was reasonably under control. I applied for medicaid for her, so that she might remain in this facility. She insisted after three months on signing herself out, so she could go home again to an upstairs apartment, to be with my father, a man who had abused her, her whole marriage. I begged her to stay put, because I felt it would be a death sentence, if she went back to that apartment, to be a prisoner again to chronic pain, and the depression of living with my father, never getting her needs met. I refused to go along with it, and even took a job in this LTC facility, hoping that she would stay. I couldn't prevent her signing out however, as she was in her rights to do so. On Sept. 15th, she signed out, and since I refused to pick her up, my father drove to get her in his rat trap car. When she got back home, she could not get the proper medication for her back, that had been prescribed for her in the LTC. So, it was a very short trip back into depression and despair, which is a vicious cycle in chronic pain. That was Sept. of '95, and by Nov. '95, she was dead; almost one month to the day after she signed out.

Aug 19, '00

PPL that's so awful! I am so sorry to hear that her life ended up like that. It must have been horrible to see her leave the LTC facility.